Archive for Education/Curriculum

The Buzz at Booth 628  

Posted in Education/Curriculum, Field of Family Medicine, Social at 11:17 pm by mark song

From knee-high pink stockings and spandex to Michael Jackson’s famous white glove, the atmosphere was vibrant and ebullient at the massive downtown Kansas City Convention Center. Add to the mix The Spazmatics, an 80’s cover band, and what you’ve got is one serious tribute to all things 80’s. Welcome to the first day of the 2009 AAFP National Conference for Residents and Students! What could’ve been mistaken as an 80’s convention filled with fanatic Breakfast Club devotees was instead the orientation/registration day to our annual conference. As Los Angeles natives, we, of course, dressed the part, and donned white gloves and sunglasses of our own. The outfit was low-budget, extremely easy to put together, and very well received – a testament to our collective creative stretch unbound by our limited means.

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The Spiriva Guy & PharmFree Update  

Posted in Advocacy & Social Justice, Education/Curriculum, Professionalism at 11:57 pm by Casey KirkHart

If you’ve been to Primary Care Lecture recently, you may have noticed a tall, dapper gentleman standing in front of the spread of Charro Chicken – that’s the Spiriva guy, a frequent guest by the medicine department to provide food during Primary Care Lecture. They organize Primary Care Lecture Series during the 2nd half of the year and do NOT have a PharmFree policy like we do.

As you all know, in 2006 our department (residents and faculty alike) voted to become PharmFree, and as our policy states our Department cannot prohibit you from partaking in Pharm food, only caution you to the dangerous influence that interactions with drug company reps can have our your clinical judgement and patient care (statements all supported by evidence).

In fact, in January 2009, we saw a new policy (entirely voluntary, mind you) put out by the pharmaceutical industry itself that limits its interactions with physicians. You will see much less Pharm swag; Pens, pads, squishy stress balls will be a thing of the past. Also, the policy states that FOOD MAY BE provided but as part of an educational or informational event by the rep. Technically, since the Spiriva guy has no relation to the topic of PCLS (unless it is of course about COPD), his provision of food violates the pharm companies’ own policy. Just something to think about. Here is the policy: http://www.phrma.org/files/PhRMA%20Marketing%20Code%202008.pdf

And in case you were wondering, PharmFree policies such as ours are mainstream. AMSA has put together a very nice Scorecard that describes the policies of nearly all medical schools. The culture of medicine is, in fact, changing, and you lack of exposure to drug reps is becoming the norm. Visit http://www.pharmfree.org/ for more info.

As you also know, I am just about to purchase a subscription to the Medical Letter, on behalf of EVERYONE in the department, with the money we have “earned” though the CoMed study with Marcy. You will see how the Medical Letter will be integrated into your education in the near future.

I hope this adds some clarity to our policy and spurs some conversation, something we havent had regarding this topic in a while.

Thanks for reading.

~Casey

Don’t Get Sick in July?  

Posted in Education/Curriculum, Field of Family Medicine at 9:47 pm by Casey KirkHart

If you happen to get sick this summer in Southern California and you wind up at my hospital, you can expect to find a gaggle of eager, intelligent, competent and caring new, young doctors (we like to call them ‘interns’) ready to listen intently to your story, as well as your heart and lungs of course. They may be ‘green’ but they certainly aren’t dangerous so long as they’re armed with 2 important tools: supervision & sleep.

The former seems blatantly lacking the story quoted below.

Every neophyte is owed the opportunity to be taught so long as the teacher recognizes her imperative to teach. Especially in a hospital in July.

New Docs on the Block

According to medical lore, July is the worst time to be hospitalized because that’s when inexperienced med students start clinical training. But is summer really riskier for patients?

A month into Sandeep Jauhar’s medical internship at a prominent teaching hospital in New York City, he was asked to drain fluid from the belly of a patient who was HIV-positive. “I was trying to get out of the hospital to keep a dinner appointment,” he recalls. “I was sort of rushing. I heard a snap and there was all this fluid leaking all over the floor.” Jauher’s gloves were too small, he hadn’t assembled the tubes for the blood correctly, he was new, he was inexperienced and nobody was watching. “[The patient] was totally oblivious to the disaster, but it was a mess,” he says. “These are the mistakes that new, green interns can make.”

According to conventional wisdom, a patient’s chances of encountering a mistake-prone rookie like Jauhar go way up in the summer. That’s because July 1 is the start of the academic year for medical schools: In teaching hospitals around the country, medical students will replace interns, interns will replace residents and residents will move on to fellowships or to become full doctors.

This crucial and sometimes perilous training period can be incredibly difficult for medical students. As Jauhar writes in his recent book, “Intern, A Doctor’s Initiation,” incoming doctors are not only practicing on patients for the first time, they’re also learning the often Byzantine workings of their respective hospitals, new technical language, new procedures and the tedious, yet critical, ways to fill out paperwork. All this learning is packed into 80-hour workweeks and overnight shifts in a busy hospital environment—a far cry from the academic environment they might be coming from. But is it really riskier to go into a teaching hospital during those first few weeks of intern training? Or is the “July phenomenon” a medical myth?

Finish reading at New Docs on the Block

~casey

from the desk of the Resident Clinic Director – improving patient care and diabetes  

Posted in Education/Curriculum, Field of Family Medicine at 10:51 pm by Casey KirkHart

Hi all. No, not another anti-Pharm diatribe from me. This one is a clinical diabetes case from the Harbor-UCLA family medicine clinic:

You all know that a few of us family med residents have been involved in the diabetes chronic care collaborative with Drs. Snyder and Cheng. We’ve been trying to provide intensive and attentive care (including testing, treatment, education, and self-management) to our most out-of-control (OOC) diabetic patients. As the Resident Clinic Director (aka “RCD”) for the last month (a required and worthwhile rotation as a 3rd year resident), I’ve been on the front line of patient care at the Family Health Center. Here’s an example from today’s RCD experience that shows what we’re up to.

* Please email me if you’re interested in participating in the chronic care collaborative!*

One of our nurses, Mahdi, alerted me to a patient with fasting blood sugar 256. (This is something you have to address in the few spare minutes you have while RCD between triaging urgent care patient, writing for med refills, and putting out the occasional fire (ie someone with chest pain, residents swamped with clinic, etc) that erupts in the waiting room. It’s fun, actually.) This 66 year old Latina lady with her daughter at her side explained that she’s NEVER been in control of her diabetes in the 15 years she’s had it. Her last Hemoglobin A1c in 1/07 was 9.8% (far above her goal of 7%). Her home sugars run 200 to 400. She’s been seen only a couple of times here, but already her meds are maxed out: metformin 2500mg a day (about max dose), pioglitazone [Actos] 30, glipizide 20 bid (max). So, fair doctor, what do you do?!

Obviously her oral meds aren’t doing it. Your choices are: increase the Actos to 45 a day (max dose)? Start a 4th agent – acarbose, Januvia? All of the above? Start insulin? Take a second: based on what you know about this lady’s diabetic control, how can you best help her?

Well, a little bit more of the story helps. First, she and her daughter are asking for insulin. That doesn’t happen too often (many of our patients fear that insulin causes blindness, amputation, etc – Educate patients, people!), but when someone has a chronic, debilitating condition that isn’t helped with maxed oral meds, she knows that only insulin can help her. Smart lady. Fortunately she’s been given insulin in the past so knows the routine. I start her on NPH 10 units (she’s thin, so 10 is a good start. If she’s obese, I might start 16 units) before bed and counsel her on increasing the dose every 3 days by 2 units if her AM fasting sugars are >130. Both she and her daughter understand, but adjusting insulin like this is tough for newbies; she might need more counseling in the future…

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